More doctors and better health care

UC Davis' proposal will increase the number of medical students it trains, with an emphasis on improving health care for residents living in the rural and more remote areas of California.

UC Davis School of Medicine has an approximately $35 million proposal in the works that will help increase the number of medical students it trains and establish the school as a statewide hub for medical telecommunications, all with an emphasis on improving health care for residents living in the rural and more remote areas of California.

UC Davis plans call for significantly expanding a rurally focused program for its medical students and strengthening the school's existing telemedicine infrastructure and outreach efforts to help address the physician shortage problems that the state is expected to experience in the coming decade.

Officials anticipate that much of the funding for the proposal will come from Proposition 1D, the $10.4 billion ballot measure approved by California voters in November. That initiative provides the entire UC system with nearly $700 million for facilities construction and an additional $200 million to expand medical school programs and enhance telemedicine efforts throughout the state.

“Passage of Proposition 1D provides a tremendous boost to UC Davis programs that provide quality health care to underserved populations in California,” said Thomas Nesbitt, executive associate dean for administration and outreach and founder of the UC Davis telemedicine program. “We not only need to produce more doctors dedicated to practicing medicine in smaller communities, but we also need to take advantage of the innovations in telecommunications, which enable highly trained specialists in big city medical centers to share their expertise with more rural clinics and hospitals.”

Compared to the state's urban areas, rural populations typically have fewer health-care providers per capita and suffer from higher rates of chronic disease, hospitalization and cancer deaths. As the leading medical referral center for much of Northern California, UC Davis School of Medicine has been able to take the lead in advancing the use of high-speed video-conferencing technology, or “telemedicine,” to link its specialists for consultations with health-care providers in smaller communities that lack the local expertise.

Another UC Davis program called the “Programs in Medical Education-Rural,” or PRIME-Rural, is focused on increasing the number of physicians practicing outside of large urban areas. Current predictions estimate that within a decade the state will face a shortage of between 5,000 to 17,000 doctors, especially in rural areas. As part of a long-range plan to increase medical school enrollments throughout the entire UC System, UC Davis plans to add 12 medical students per year over the next four years — from 93 to 105 students per class — with the new enrollees agreeing to a more rurally-focused curriculum and clinical experience.

The telemedicine resource facility is designed to complement PRIME-Rural by establishing a state-of-the-art communications hub between Sacramento and locations around the state. It would be the lead resource for telehealth efforts among the five UC medical schools, providing assistance ranging from establishing best practices for various clinical applications to providing advice on state and national health-related telecommunications policies.

“Our telemedicine resource center,” Nesbitt said, “can play a vital role in the long-term success of various rural initiatives, not only for UC Davis, but throughout the state. Improving telecommunications in medicine is the perfect complement to training more physicians to practice outside of big cities and it's an ideal way to help close the health-care gaps in underserved regions.”

The UC Davis proposal builds the infrastructure needed to create a permanent, system-wide hub for high-speed interactive medical consultations and education, often termed “telehealth” or “telelearning.” For rural communities, having real-time access to health-care specialists via videoconferencing connections is crucial to improving quality of care for local residents.

UC Davis also envisions that its medical students will use telemedicine connections to frequently link back to the medical center in Sacramento for both educational content and clinical support. Specialized videoconferencing units also will be located throughout the medical center, providing quick access to faculty members who will be mentors for students in the field.

UC Davis' current telemedicine program began in 1992 as a fetal monitoring project that connected perinatal specialists in Sacramento with a small hospital 70 miles away. Since that time, the program has provided more than 14,000 medical consultations at 110 clinics and hospital sites around the state.

In October, Gov. Arnold Schwarzenegger attended a UC Davis pediatric telehealth conference, where he announced the signing of an executive order to improve broadband connectivity in California. Enhancing broadband technology is a key element in creating better access for the remote areas of the state where specialty health care is not easily available.

At the most recent UC Board of Regents meeting, the board considered recommendations on the need to increase enrollments at its medical schools — along with its schools of nursing, pharmacy, public health and veterinary medicine — to help meet the growing work force needs in health care. The Regents later approved a budget plan that includes funding from Proposition 1D for projects associated with expansion of medical school programs, such as those included in the UC Davis proposal for the telemedicine resource center and PRIME-Rural program. The proposed medical school class size at UC Davis also will be reviewed by the Liaison Committee on Medical Education, which is the nation's medical school accrediting authority.